Q Exchange
Everyone can be at the frontline of Quality Improvement
- Winning idea
- 2020
What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?
London Nightingale Hospital was a test bed for new ideas. One of MSEFT’s clinical facilitators volunteered at Nightingale and was key in developing the “Bedside learning coordinator” role, a success during the pandemic surge. Together with Prof Richard Bohmer and UCLP AHSN, they designed the learning system, helping the hospital remain safe while improving care. The coordinator introduces a cycle of learning, enabling staff to identify & resolve problems while delivering care. Through structured real-time observation and reporting for both local action and escalation to a leadership level, solutions are put in place to improve the environment within 72 hours. This empowers teams, creating a culture of engagement and involves a wider team of colleagues in improving care.
This concept is being adapted in Essex by the Clinical Directors for Improvement and rebranded to Frontline Learning Coordinator (FLC) while collaborating with Richard, UCLP and Royal Free who are also implementing the idea.
What does your project aim to achieve?
Our ambition is to embed the bedside learning coordinator across all of our acute hospital sites and eventually our community bed base, helping staff from all disciplines both clinical and non-clinical to take part. Moreover, we would like to go beyond clinical areas to see if similar roles can deliver improvement in areas such as corporate services, sterile services, patient and client customer care etc. This will be part of our initial experiment with this project.
Learning from the Nightingale and Royal Free experience, we aim to develop and adapt this role for our DGH/Acute Trust setting, creating a local learning system and then to share our learning and further develop this project/role for spread across the UK via a Learning community on Q and by publishing the findings, to spread the learning internationally.
How will the project be delivered?
We will use learning from our colleagues from UCLPartners and Richard Bohmer who led this work at Nightingale, and are helping our clinical leaders in Essex. We are building on our local knowledge, starting in the Emergency Department and will do PDSA cycles of improvement. We will endeavour to have FLCs on 3 acute sites in 3 different clinical areas – so scaling to OPD, Maternity Unit and ITU.
We plan on building support for the FLC role through local improvement champions through developing learning packages, whilst we recruit a clinical improvement fellow to support rollout, measurement metrics and an evaluation framework. This project is one of the key priorities for the improvement team this year and has already gained support of the executive team and our Clinical Strategy Board. We aim for the role to become a key feature of ward and departmental establishments in all areas.
How is your project going to share learning?
– At Q community level: This project is being trialled in Barts Health and the Royal Free London, who are working with staff from NHS Nightingale and UCLPartners. The Association of Groups’ are developing learning sets on improvement and FLC as well. We will work together to share our learning, measuring and tracking our progress through our improvement team. This will be through communities of practice – one per quarter.
– At local/regional level: Comms campaigns will be targeted to (1) engage nursing community, internally in the pilot, the overall MSE improvement strategy and Q community (2) disseminate learning to non-clinical areas (3) disseminate learning to other organisations e.g. community and mental health in MSE
– we expect all learning to be delivered via webinars and share our experience on social media and electronic publications. We feel that this model for bedside improvement is manageable and scalable within our busy COVID-19 world.
How you can contribute
- Collaborators especially when we are disseminating the learning.
Plan timeline
| 14 Mar 2021 | Project set up for Q exchange learning funding |
|---|---|
| 30 Jun 2021 | Community of practice 1 - Q community |
| 30 Jun 2021 | Completion of pilots for clinical areas (impacted by wave 2) |
| 30 Jun 2021 | MSE Wide Implementation campaign - clinical |
| 30 Sep 2021 | Evaluation report complete |
| 30 Sep 2021 | Plan for development of learning for non clinical areas |
| 31 Oct 2021 | Community of Practice 2 - Q community |
| 31 Jan 2022 | Community of Practice 3 - Q community |
| 31 Jan 2022 | MSE Completion of sharing learning with Community and mental health |
| 30 Apr 2022 | Community of Practice 4 - Q community |
| 30 Apr 2022 | Completion of MSE Wide implementation |
Project updates
30 May 2023
https://pq.hosting/de/vps-vds-hong-kong-china
25 May 2023
4 Oct 2021
The project is going very well. We now have an FLC at two of our three sites and the feedback from staff is overwhelmingly positive. We are about to launch in one of the departments at our third site, building on the lessons we have learnt so far.
Staff report feeling empowered and the vast majority of issues raised are solved rapidly and at a local level.
See the attached project on a page report and feedback from staff in the departments.
We are now starting to do our formal evaluation and will feedback when we have this.
27 May 2021
We are pleased that the community of practice is now starting in conjunction with UCLP and we are also planning a special interest group within Q.
We have appointed a clinical lead for our Frontline Learning Coordinator (FLC) project and it is now live in 2 areas at 2 sites in our Trust (ED and maternity) and we are just completing our first 1 month review of outcomes.
We are starting to design a short eLearning package for future FLCs and hope to have this ready for sharing over the next few months.
Comments
paula clarke 20 Oct 2020
Creating a positive legacy from the learning from the nightingales and the Covid response is essential and this proposal is a key example of how we can build on the BLC concept/model and evidence benefits impact in our BAU operations. We adopted the BLC model in the planning for Nightingale Bristol alongside creating a completely paperless critical care unit to enable real-time data informed decision making. i would be very keen to both support and engage in this learning set proposal to maximise evidence and spread.
Elizabeth Bradbury 5 Oct 2020
Hi, well done on an interesting proposal and good luck! I wonder if aspects of human factors training might be useful to help address some of the human responses to change management that the teams are likely to encounter? Here's the question that occurred to me when I read the paper you mention, it might be worth thinking through you response for the next stage of your proposal: '..what advice do the authors have for applying this in an environment that doesn’t have the pressing need or unifying presence of a pandemic? Much of the feedback when I was leading Covid crisis learning capture was about rapid if not real time decision making and significantly simpler governance and decision making processes but I imagine that panels and ref groups would quickly tire of microsystem discussions and attendance would wane as the urgency decreased. Like many fellows I visited InterMountain and was inspired but some of the mechanism they used to engage staff wouldn’t necessarily work in our health & care system.'
I've heard Chase Farm at RFL has introduced a 3x/week learning debrief, akin to the NG clinical forum
Good luck!!!
Aroon Lal 8 Oct 2020
Dear Elizabeth
Thank you for your very helpful comments. One of our team is an experienced Human Factors trainer and we will definitely be looking to train and support our coordinators in this. We agree that without the urgency of the pandemic and with the return of tighter controls on change and innovation, we are looking at a different environment and this is one reason why we are not looking to simply reproduce the Nightingale model. What we learn from this project is likely to be very relevant to others. Thanks for the tip about Chase Farm.
Nima Roy 1 Oct 2020
Chase Farm Hospital (Royal Free) has begun testing the BLC role with a similar rationale. I'll be supporting this soon so would be great to connect and share learning? My email address is n.roy@nhs.net if possible?
Many thanks,
Nima
Preeti Sud 16 Oct 2020
Hi Nima, we are connected with colleagues in Roya Free. I will share your name with the internal team as well, so this will all be connected. Glad to see you involved here. anything you learn that could help develop this proposal further, do let us know.
Aroon Lal 5 Oct 2020
Hi Nima
Thanks for letting us know. We would definitely like to share with you and will email you to see how we can best do this.
Nima 1 Oct 2020
Thanks Elizabeth- I hope you're well!
Elizabeth Beech 1 Oct 2020
Hi Nima - lovely to see you in the Q community
Sarah Morgan 1 Oct 2020
I was really taken by this idea when I heard Nightingale had initiated it. Very keen to learn from this as it picks up on some of the challenges we have heard fed back from our critical care teams in particular.
Aroon Lal 5 Oct 2020
Hi Sarah
It's definitely our intention to share our experience as widely as possible via Q and other forums.
Elizabeth Beech 30 Sep 2020
This is a good proposal, building on what seemed to be an effective innovation in a Nightingale Hospital, and one that seems so adoptable. So great to see it tested and what adopts and what adapts to a different environment
Aroon Lal 5 Oct 2020
Thanks Elizabeth. We are very excited. Like you, it will be good to take this to another environment to see how to adapt and embed.
Brefne Jowers 30 Sep 2020
Dear Aroon, this reminded me of an initiative i saw a presentation on some years ago - https://www.nhsconfed.org/blog/2013/06/it-takes-an-onion--not-an-eon--to-bring-about-changes-with-impact-for-patients-says-samantha-jones
I don't know whether it continued after Sam Jones left West Herts but it might be good to connect with somebody there?
Best wishes,
Brefne
Aroon Lal 5 Oct 2020
Thanks Brefne, it's a good link. I believe 'The onion' is still working, but will definitely explore this further. I think embedding this sort of immediate action at a ward level will build on this approach.
Comments are now closed for this post.